B32 - Chapter 3.doc

Abnormal psych chapter 3
Diagnostic and statistical manual of mental disorders (DSM) now in its 4 edition,
commonly referred to as DSM IV or DSM IV-TR. The DSM is published by the
American psychiatric association
A BRIEF HISTORY OF CLASSIFICATION
Bloodletting was part of treatment of all physical problems
Development of the WHO and DSM systems
In 1939 the world health organization (WHO) added mental disorders to the international
list of causes of death
In 1948 the list was expanded to become the international statistical classification of
diseases, injuries and causes of death (ICD) a comprehensive listing of all diseases
including a classification of ab beh. Metal disorders section was not widely accepted
American psychiatric association published its own diagnostic and statistical manual
(DSM) in 1952
In 1969 the WHO published a new classification system that was more widely accepted.
A 2 version of the American psychiatric associations DSM, DSM-II was similar to the
WHO system
The WHO classifications were simply a listing of diagnostic categories; the actual beh or
symptoms that were the bases for the diagnoses were not specified
In 1980 the American psychiatric association published an extensively revised diagnostic
manual; a somewhat revised version DSM-III R appeared in 1987
DSM IV is used throughout the U.S and Canada is becoming widely accepted around
much of he world
THE DIAGNOSITIC SYSTEM OF THE AMERICAN PSYCHITIARTC ASSOCIATION
(DSM-IV AND DSM-IV-TR)
The term mental disorder is problematic and that no definition adequately specifies
precise boundaries for the concept. DSM-IV-TR provides the following definition:
A clinically significant beh or psychological syndrome or pattern that occurs in an indiv
and that is associated with present distress or disability or with a significantly increased
risk of suffering death, pain, disability or an important loss of freedom
Five dimensions of classification
Most sweeping change in the use of multiaxal classification whereby each indiv is rated
on 5 separate dimensions or axes
The five axes are:
1) axis I- all diagnosis categories except personality disorder and mental retardation
2) axis II- personality disorders and mental retardation
3) axis III- general medical conditions
4) axis IV- psychological and environmental problems
5) axis V current level of functioning
most ppl consult a mental health professional for an Axis I condition
although the remaining three axes not needed to make the actual diagnosis their inclusion
in the DSM indicates that factors other than a persons symptoms should be considered in
an assessment so that the persons overall life situation can be better be understood axis III conditions may be quite common. A recent study in Toronto found that more tan
half of the inpatients had an identifiable medical condition and that having an infectious
disease was associated with disruptive beh
these include occupational problems, economic problems, interpersonal difficulties with
family members and a verity of problems in other life areas that may influence
psychological functioning
life areas considered are social relationships, occupational functioning are supposed to
give info about the need for treatment
Diagnostic Categories
the DSM indicates that the disorder may be due to a medical condition or substances
abuse
DSM-III there has been a dramatic expansion of the # of diagnostic categories
Issues and possible categories in need of further study BOX
Caffeine withdrawal- caffeine withdrawal results in significant distress or impairment in
occupational or social functioning. Symptoms include headache, fatigue, anxiety,
depression, nauseas and impaired thinking
Premenstrual Dysphoric disorder- this proposed syndrome occurs a week or so before
menstruation for most months in a given year and is marked by depression, anxiety,
anger, mood swings, and decreased interest in activities usually engaged in with pleasure.
The symptoms are severe enough to interfere with social or occupational functioning.
This category is to be distinguished from premenstrual syndrome which is experienced by
many more women and is not nearly as debilitating
Daily charting or symptoms for at least two menstrual cycles
On the plus side inclusion might alert ppl to the hormonal bases of monthly mood
changes linked to the menstrual cycle and thereby foster more tolerance and less blame.
On the minus side listing such mood changes in a manual of mental disorders could
convey the message that women who experience these psychological changes are
mentally disordered
Mixed anxiety- depressive disorder- in mixed anxiety depression disorder, a person
would have depressed for at least a month and have had at the same time at least four of
the following symptoms: concentration or memory problems, sleep disturbances, fatigue
or low energy, irritability, worry, crying easily, hypervigiliance, anticipating the worst,
pessimism about the future and feelings of low self esteem.. the person must not be
diagnosable as having a major depressive disorder, dysthymic disorder, panic disorder, or
generalized anxiety disorder
Passive aggressive personality disorder (negativistic personality disorder)
Not attributable to depression, symptoms include resenting, resisting, and opposing
demands and expectations by means of passive activities such as lateness,
procrastination, forgetfulness and intentional inefficiency. The inference is that the
person is angry or resentful and is expressing these feelings by not doing certain things
rather than by being assertive or aggressive. Such ppl often feel mistreated, cheated or
under appreciated
Depressive personality disorder- ppl whose general lifestyle is characterized by chronic
gloominess, lack of cheer, and a tendency to worry a lot. This trait like long term disorder
may be a precursor to a full blown major depressive disorder. Its very difficult to
distinguish between depressive personality disorder (DPD) and the main depressive
disorders Its possible on a statistical basis to distinguish DPD and dysthymia which is a milder bu
long lasting form of depression. However they also found that 95% of the ppl who meet
diagnostic criteria for DPD also meet the diagnostic criteria for dysthymia
DPD is a subtype of dysthymia
Another disorder listed in the DSM-IV-TR is minor depressive disorder which may be
distinguishable only by virtue of its not being as long lasting as depressive personality
disorder
Proposed axes in need of further study---- defence mechanisms defined as automatic
psychological processes that protect the indiv against anxiety and from the awareness of
internal or external dangers or stressors.
Defence mechanisms are divided intyo groups called defence levels and are measured by
a proposed defensive functioning scale
There are 7 defence levels each with a set of defence mechanism. The levels range from
high adaptable level to level of defensive dysregulation
High adaptive level- this most adaptive healthy defence level contains coping efforts that
are realistic ways of handlings tress and are conducive to achieving a good balance
among conflicting motives
The following are some ex:
Anticipation- experiencing emotional reaction before a stressful event occurs and
considering realistic altenbrative courses of action ex: planning for an upcoming meeting
with an employer who is unhappy with your performance
Sublimination- dealing with a stress by channelling negative feelings into socially
acceptable beh ex: working out at the gym
Disavowal level- this middle level is characterized by defences that keep troubling
stressors or ideas out of consciou